Completion Thyroidectomy: Safer than Thought

Abstract

Background: The aim of this study was to find out whether a substantial difference in terms of complication rates exists between primary and completion thyroidectomies following initial bilateral subtotal thyroidectomy in the light of current literature and our series. Patients and Methods: Total number of 696 patients who received completion thyroidectomy (Group 1, n = 289) and total thyroidectomy for differentiated thyroid cancer (Group 2, n = 407) and their data were reviewed and postoperative complications were compared between the groups and with the literature. Results: Transient and permanent hypocalcaemia rates were 20% and 5.8% in Group 1 and 10.5% and 5.1% for Group 2 respectively. Unilateral transient, bilateral transient and unilateral permanent recurrent laryngeal nerve palsy rates were 6.2%, 1.3% and 4.4% for patients in Group 1 whereas same complications were seen in 4.6%, 0.7% and 3.6% of patients in Group 2. When groups were compared for complications; temporary hypocalcaemia, unilateral temporary nerve palsy, and minor wound infection rates were statistically higher in Group 1, with no significant difference in permanent complications. Conclusion: When complication rates of re-operation after bilateral subtotal thyroidectomy and primary total thyroidectomy for differentiated thyroid cancer were compared in an unbiased fashion, completion thyroidectomy was shown to be as safe as a primary operation with regard to permanent complications.

Completion thyroidectomy: is timing important for transcervical and remote access approaches?

“…Gulcelik et al 21 In a prospective study included 287 patients with completion thyroidectomy and 407 with total thyroidectomies. The rates of complications were compared resulting in significant differences in the rates of temporal hypocalcemia, unilateral temporary paralysis of the recurrent laryngeal nerve and infection of the operative site.…”

What Should We Prefer in the Surgical Management of Differentiated Thyroid Carcinomas?

“…The reasons that cause surgeons to feel anxious about completion thyroidectomy are the difficulty of dissection to be caused by broken neck anatomy and the complications that may develop accordingly. The rates reported by Gulcelik et al (23) for permanent vocal cord paralysis and permanent hypoparathyroidism after completion thyroidectomy were 2.5%. Park YM (24) mentioned only 2% temporary vocal cord paralysis in a series of 100 cases.…”

“…In the practice of thyroid surgery, the tendency to completion total thyroidectomy is common, especially in patients who underwent partial thyroidectomy for the solitary thyroid nodule but were later diagnosed with differentiated thyroid carcinoma. The fact that the possibility of multicentric carcinoma increases the risk of subsequent local recurrence in the contralateral thyroid lobe and the expectation for a facilitating effect for ablation treatment when required after this approach is argued as the main indications for the method (22,23). The incidence of residual carcinoma in the contralateral lobe obtained with completion thyroidectomy was reported to be 28% by some authors and 27% by Rao et al (20)(21).…”

Completion Total Thyroidectomy Is Not Necessary for Papillary Thyroid Microcarcinoma with Occult Central Lymph Node Metastasis: A Long-Term Serial Follow-Up

“…Since the most common recurrence site of PTMC was the contralateral lobe, we were faced with a dilemma of whether to perform completion total thyroidectomy. Several studies have reported that 2–7% of patients experience transient recurrent laryngeal nerve (RLN) palsy; 0.5–4.4%, permanent RLN palsy; 7–20%, transient hypoparathyroidism; and 2.5–5.8%, permanent hypoparathyroidism after completion total thyroidectomy [ 44 , 45 , 46 , 47 ]. Although the incidence of complications is low, the risk of complications can be completely circumvented by avoiding unnecessary surgery.…”